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HomeMy WebLinkAboutG-13-845 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK i t i Vie! CITY Yarmouth MA DATE 3/18/13 PERMIT# 1 JOBSITE ADDRESS 172 North Main Street M# 80 / P# 134 OWNER'S NAME: O'Donnell GOWNER ADDRESS SAME TEL FAX TYPE OR ' OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL 0 RESIDENTIAL El PRINT CLEARLY NEW: ® RENOVATION: 0 REPLACEMENT: ❑ PLANS SUBMITTED: YES 0 NO❑ 7o.00 ; APPLIANCES 1 FLOORS-. BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 ', BOILER BOOSTER CONVERSION BURNER COOK STOVE I1 -DIRECT- VENT HEATER1 DRYERI YFIREPI CE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED-HEATER � - TASRA OVEN UNIT BOUPAIR7 NIT r _ __. _.._... ._.......".,I POOL HEATER Pgs40;4)J 5 `ROOM—SPACCREATER s t.rr 4 ROOF TOP UNIT TEST . .. UNIT HEATER -INVENTED ROOM:HEAVER -WATEWflEATE=R 01HER '1/4}%96%5 1 -, _ - I IN URANC •r 1, I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 YES ® NO 0 I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY ® OTHER TYPE INDEMNITY 0 BOND 0 OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER 0 AGENT 0 SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this application are true and ac • ate t. •- •-st of my k •wledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance wit . Pertin'• provision of th- Massachusetts State Plumbing Code and Chapter 142 of the General Laws. S. PLUMBER-GASFITTER NAME:James Pazakis LICENSE#PL-15030-M •IGNAIr MP ® MGF❑ JP 0 JGF 0 LPG! D CORPORATION ® #2803 -.1'TNERS ' ❑# LLC❑# COMPANY NAME Hall Plumbing & Heating, Inc, ADDRESS 447 • r Chatham 2 (Road p �q CITY South Dennis STATE MA ZIP 02660 TEL 508-385-9127 U) 15 l'U "1 U D FAX 508-385-6604 CELL EMAIL HallTechnician(a comcast.net AJ R 19 2013 ex set * /i GU:LDL PT — — • ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No A/� U� J . ��` /3 � 910 THIS APPLICATION SERVES AS THE PERMIT ❑ 0 �G/ lll�/ l //u( FEE: $ PERMIT# PLAN REVIEW NOTES • iy . S3 ''aI--- MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK IC., I a CITY Yarmouth MA DATE 3/18/13 PERMIT# S J‘ JOBSITE ADDRESS 172 North Main Street M# 80/ P# 134 OWNER'S NAME: O'Donnell GOWNER ADDRESS SAME TEL FAX „, TYPE OR : OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL 0 RESIDENTIAL in PRINT CLEARLY I NEW: ® RENOVATION: 0 REPLACEMENT: ❑ 70.00 PLANS SUBMITTED: YES 0 NO❑ APPLIANCES 7 FLOORS—. BSM 1 2 3 4. 5 6 7 1 8 1 9 1 10 11 1 12 13 14 BOILER I I . �-_ __... ___-_ I BOOSTER f ( CONVERSION BURNER 1 i COOK STOVE I • I I 1 I DIRECT VENT HEATER 1 1 DRYER I I FIRED- -CE I I I 1FRYOLATOR FURNACE ,__. l ; GENERATOR i GRILLE I IINFRARED-HEATER I I LABORATORY COCKS ; I MAKEUP AIR UNIT � IOVEN St:�1 p� I IPOOL HEATER Pt tl r yl '3 '- I I I tDOMT-SPACE REAJER B : I I I ROOF TOP UNIT i I TEST l t j UNIT HEATER j I UNVENTED ROOM HEATER , 1— I J II ATER ffEATERI I ( OTHER yvp('nj I 1 1 I f IN URANCECOVERAGE I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142 YES © NO ❑ I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW t LIABILITY INSURANCE POLICY al OTHER TYPE INDEMNITY 0 BOND 0 OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. CHECK ONE ONLY: OWNER 0 AGENT 0 1 SIGNATURE OF OWNER OR AGENT I ere.y certi t at all o e•etails an. in ormation ave su•mitte•or entered regarding this app ication are true an. ac • ate t�1.- *est o my 'Wedge an•that 1 all plumbing work and installations performed under the permit issued for this application will be in compliance wit . Pertiny provision of th- Massachusetts State Plumbing Code and Chapter 142 of the General Laws. a_ 1 PLUMBER-GASFITTER NAME:James Pazakis LICENSE#PL-15030-M .IGNAT.iJ;l MP ® MGF❑ JP 0 JGF ❑ LPG(,❑ CORPORATION ® #2803 9'TNERS ❑# LLC D# 1 COMPANY NAME Hall Plumbing & r Heating, Inc, ADDRESS 447 . • Chatham Road �pt - CITY South Dennis STATE MA ZIP 0266Q TEL 508-385-9127 p ET, 7 9 1', [E I' I I FAX 508-385-6604 CELL EMAIL HallTechnicianc comcastnet pyo 1 0 2013 lo/ CR i Set' * uci;c9' LEFT �- ,- --. •- roD